Healthcare Provider Details

I. General information

NPI: 1295576403
Provider Name (Legal Business Name): INNOVATION HEALTH AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 E GRAND RIVER AVE STE 203
EAST LANSING MI
48823-4988
US

IV. Provider business mailing address

1331 E GRAND RIVER AVE STE 203
EAST LANSING MI
48823-4988
US

V. Phone/Fax

Practice location:
  • Phone: 517-318-6725
  • Fax:
Mailing address:
  • Phone: 517-318-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BRIAN SZAGESH
Title or Position: MEMBER
Credential: DC
Phone: 989-277-2760